Summary
Jane Cummings, the Chief Nursing Officer for NHS England has written about a Winter Framework designed to reduce delayed discharges by maximising the use of care homes across each Sustainability and Transformation Partnership (STP). Therapy-led units, too, will be promoted to focus on reablement and rehabilitation, in order to make patients more ready for discharge from hospitals.
Reference
England’s top nurse launches new winter support package to help patients stay active and leave hospital. [Online]: NHS England, December 18th 2017.
See also:
Reference
Framework to support winter pressures 2017-18: Framework for maximising the use of care homes and use of therapy-led units for patients medically fit for discharge. [Online]: NHS England, December 2017.
This relates to:
Reference
Framework for maximising the use of care homes and use of therapy-led units for patients medically fit for discharge. London: NHS England, December 2017. Publications Gateway Reference No.07483.
On Reducing the Patient Deconditioning Effect(s) of Remaining in Hospital Beds Unnecessarily (aka Pyjama Paralysis / PJ Paralysis)
“ …for those over 80 years old, a week spent in bed can equate to 10 years muscle ageing, a loss of 1.5kg of muscle mass and a 20% reduction in aerobic capacity. It can also lead to a five-fold increase in the risk of requiring institutional care… 47% of delayed transfers of care [are associated with] deconditioning”.
Reference
Cummings, J. (2017). Valuing patients’ time. [Online]: NHS England, November 24th 2017.
The Don’t Write Them Like They Used To…
This bed-related deconditioning phenomenon has been known about since 1947, at least. The following classic article is written in a characteristic 1940’s lively prose style, with some distinctive faux-literary embellishments rarely seen in the current austere medical literature:
Reference
Asher, RA. (1947). The dangers of going to bed. British Medical Journal. December 13th 1947; 2(4536): 967.
The 70-Day National Challenge
Professor Jane Cummings, Chief Nursing Officer for England, launched the national campaign to get patients up and dressed in their own clothes, with the aim of promoting their faster recovery, at the 2018 Chief Nursing Officer Summit. The “70-day challenge” hopes to save a million patient days from being squandered in hospitals in a 70 day period.
“A recent pilot gave patients back 91,728 days or 250 years’ worth of time across nine trusts in the East of England as result of getting patients up and dressed”.
Reference
Cummings, J. (2018). 70 days to end pyjama paralysis. [Online]: NHS England, March 5th 2018.
May 2018 Updates
Two articles reflect progress and growing awareness:
Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).
Reference
Peate, I. (2018). Putting an end to pyjama paralysis: the benefits. British Journal of Nursing. May 10th 2018; 27(9): 471.
Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).
Reference
Oliver, D. (2018). David Oliver: Fighting pyjama paralysis in hospital wards. BMJ. May 2nd 2017; 357: j2096.
Ideas, and an Ipswich Hospital NHS Trust implementation case study, recognised by NICE:
Reference
‘Get up, Get Dressed’: Frailty Care on a Surgical Ward. [Online]: Lavenham Ward at Ipswich Hospital NHS Trust [and] National Institute for Health and Care Excellence (NICE), July 2018.
Hospital-Associated Deconditioning (Deconditioning in Hospital)
Ten days stay in hospital results in ten years ageing (for the elderly)? A discussion concerning the benefits of early patient mobilisation. (Occurs between around 9 minutes 10 seconds and 19 minutes 40 seconds in programme).
Reference
Home fetal heart monitoring, Deconditioning in hospital, Alcohol harm paradox, Pre-eclampsia feedback. London: BBC Radio 4’s Inside Health, February 26th 2019.
Early Mobilisation in Hospital to Reduce Length of Stay
A systematic review indicates that early mobilisation programmes for hospital patients result in improvements to walking speed and a length of stay roughly two days shorter.
Reference
Cowley, A. [and] Fiddler, H. (2019). Getting hospital patients up and moving shortens stay and improves fitness. London: NIHR Signal, April 16th 2019.
This relates to:
Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).
Reference
Cortes, OL. Delgado, S. [and] Esparza, M. (2019). Systematic review and meta-analysis of experimental studies: in-hospital mobilization for patients admitted for medical treatment. Journal of Advanced Nursing. January 22nd 2019. [Epub ahead of print].
Promising results from Australia:
Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).
Reference
Suriyaarachchi, P. Chu, L. [and] Bishop, A. [et al] (2019). Evaluating effectiveness of an acute rehabilitation program in hospital-associated deconditioning. Journal of Geriatric Physical Therapy. August 5th 2019. [Epub ahead of print].
End PJ Paralysis: in Critical Care
Reference
Hemsley, A. (2019). #End PJ paralysis: can it be implemented within Critical Care? (EP.112). In: Intensive Care Society State of the Art 2018 Abstracts. Journal of the Intensive Care Society. May 2019; Vol.20(2); p.87.
ActNow: e-Learning Tool (e-LfH)
NHS England and Health Education England have launched the ActNow e-learning tool to help reduce lengthy hospital stays for patients. This embodies the principles of the Where Best Next? Campaign.
Reference
New NHS online training to help people get home from hospital quicker. [Online]: NHS England, November 5th 2019.
